Supplemental Digital Content 2. Summary of reports included in review (n=29)
Author
Year
Corso
1956
Subject
description
105 subjects
(210 ears),
17-25 years
old.
Normal
hearing
adults
Burns &
Hichcliffe
1957
20 subjects
(40 ears),
20-58 years
of age.
Hearing
status not
indicated
Test parameters
Diagnostic AC
audiometry.
Frequencies: .25,
.5, 1, 1.5, 2, 3, 4,
& 8 kHz).
Transducers:
Auto- oscillator
type 1011
manualoscillator type
1304-A
Audiometer:
ManualBekesy type
audiometer,
Reager Model,
AutomatedADC audiometer,
Model 50-E2
Diagnostic AC
testing.
Frequencies: .5,
1, 2, 3, 4, 6 kHz.
Transducer:
Standard
Telephones
Model 4026
Automated
audiometry threshold
seeking method
Method of AdjustmentBékésy fixed
frequency.
Frequency range of 28 kHz, starting at 40
dB.
Testing time: 10min
per ear was used with
0.5 dB rate per
second.
Thresholds obtained
by the intersection of
the midpoint curves
and specific frequency
lines.
Method of Adjustment
Békésy sweep
frequency.
Frequency range of .56 kHz was swept with
a continuous tone, in 7
min 55 sec, paper
Research findings
TestAccuracy
retest
- Average
absolute
thresholds
and
standard
deviations
-Test of
significanc
e (t-ration).
-Difference
in
variability
(F-ratio).
-Pearson
productmoment
correlation
coefficient.
- Average
difference
and
standard
deviation
- t-Test
values
- Average
difference
and
standard
deviation
s
- Product
Conclusion
Manual testing obtained
thresholds that were lower
than for automated testing
(midpoint Békésy testing).
Less variability in thresholds
was noted between .25 and
2 kHz when manual testing
was utilized.
A low statistically significant
positive correlation was
noted at given frequencies
between manual and
automated audiometry.
Overall, manual and
automated (Békésy)
threshold audiometry gives
essentially similar results.
A significant difference was
noted at 1000Hz, where
Bekesy testing yielded a
lower threshold of
Hartely &
Siengent
halar.
1964
30 subjects
(60 ears)
13 children:
4 - 5 years
old;
17 children:
8-10 years
old.
Normal
hearing
children.
Delany et
al.
1966
66 ears,
17-29 years
old.
Hearing
status not
Diagnostic AC
Testing.
Frequencies: .25,
1, 4 kHz.
Audiometer:
ManualAudiovox Model
7-B,
automatedGranson-Stadler
Model E-800,
speed of 1cm/min.
Rate of change of
intensity, increasing
and decreasing,
approximately 2
dB/sec.
Thresholds obtained
by the intersection of
the midpoint curves
and specific frequency
lines.
Method of AdjustmentBékésy fixed
frequency.
1 min fixed frequency
tracing (timed to begin
after 3 reversals on the
tracing) were obtained.
Thresholds read using
the mean mid-point
between peaks and
valleys.
Diagnostic AC
testing.
Frequencies: .5,
1, 2, 3, 4, 6 kHz.
Transducer:
4026A earphones
Method of Adjustment
Békésy fixed
frequency.
Frequencies tested at
kHz/sec.
moment
correlatio
n
coefficien
ts.
-t-Test
- Average
thresholds
- Average
difference
and
Standard
deviations
-t-Test
-Within
subject
variability
– t-Test
- Average
difference
-
-
approximately 3 dB.
Reliability was satisfactory
at all frequencies utilizing
both audiometric testing
methods, besides at 500 Hz
where the second
automated test yielded a
lowering of thresholds of 1-2
dB.
Better standard of acuity for
manual compared to
automated threshold
audiometry were obtained.
The difference was greater
for younger children than
older children.
Within subject variability for
automated threshold testing
was higher than manual
testing. Significant
difference of variability at
.25 kHz for the older group
and at 4 kHz for the younger
group.
Automated threshold
audiometry gives results
substantially in accord with
manual audiometry. The
differences over most
frequencies are small, but
indicated.
Knight
1965
66 ears.
Normal
hearing
subjects.
Jokinen
1969
4 groups:
1) 19
subjects (30
ears), 19-24
years old,
inexperience
d, normal
hearing
subjects.
2)15 subjects
(30 ears), 1924 years old,
experienced
outpatients,
normal
hearing.
Audiometer:
Automatedmobile
audiometric
laboratory,
manualnot indicated
Diagnostic AC
testing.
Frequencies: .5,
1, 2, 3, 4, 6 kHz.
Audiometer:
Manual and
automatedGrason-Stadler
model E 800
Diagnostic AC
testing.
Frequencies:
.125 .25, .5, 1, 2,
3, 4, 6, 8 kHz.
Audiometer:
Manual- Madsen
Model OB 60,
AutomatedGranson Stdler
model E800
Tone burst
presentation rate: 2
tones/sec.
automated threshold
audiometry gives lower
threshold levels.
Method of Adjustment.
Attenuator speed: 5
dB/sec, tone pulsed
2/sec.
Manual and automated
audiometry is equivalent, as
they yield threshold levels
on average that are within 1
dB.
Method of Adjustment
Békésy fixed
frequency.
Tones presented for
30 sec at a frequency,
first with 200 msec
pulsed tones, secondly
with a continuous tone.
Tone pulse, rise and
fall time of 25 msec,
with on and off ratio of
1: 1.
Intensity changes:
0.25dB steps, rate: 2.1
dB/sec.
-Average
difference
and
standard
deviation
-Average
differences
and
standard
deviations
-
-
Various differences were
seen in the 4 groups.
The normal hearing,
inexperienced and
experienced groups,
obtained better results with
automated testing (both
continues and pulsed tones)
than with manual testing.
The presbycusis group, with
and without the acoustic
trauma, indicated that
manual and continues
Békésy testing obtained the
same results, however,
pulsed Békésy testing
Gosztony
i et al.
1971
3) 9 subjects
(17 ears), 5273 years old,
presbycusis
with drop at
4000Hz
indicating an
acoustic
trauma.
4) 22 patients
(39 ears), 5381 years old,
subjects had
presbycusis
Accuracy
19 subjects.
Test-retest
reliability
46 salaried
employees
and 25 hourly
employees.
All noise
exposed
adults.
obtained better thresholds
than manual testing.
Industrial
screening AC
testing.
Frequencies: .5,
1, 2, 4, 8 kHz.
Audiometer:
Automatedself-recording
audiometer,
manualstandard clinical
audiometer.
Method of Adjustment.
- Average
thresholds
Manual testing produced
better thresholds than
automated testing , there
was a difference of 10 dB
between the two.
Test- retest reliability for
salaried employees
indicated a difference no
more than 10 dB.
In this study it was
- Average
investigated that the reason
difference
for the great difference
between thresholds was as
a result of subjects either
being influenced to claim for
HL or had compensation
cases or had compensation
legislations in progress.
Sparks
1972
15 subjects.
Bi-modal
population of
mild or
severe
hearing loss
participants
used.
Maiya, &
Kacker.
1973
20 subjects,
15-30 years.
Normal
hearing
subjects.
Diagnostic AC
and BC testing,
with masking.
Frequencies: .25,
.5, 1, 2, 4, 8 kHz.
Transducers:
AC- TDH-39
housed in a MX41 AR cushion.
BC- Radioear B70A oscillator
Audiometer:
Manual and
automatedBeltone 15-C
Diagnostic AC
testing.
Frequencies:
.125, .25, .5, 1, 2,
4, 6, 8 kHz.
Audiometer:
ManualMaico-MA-8,
AutomatedGrason-Stadler
Company model
Method of limits.
A computer program
using HughsonWestlake procedure
for threshold seeking,
masking programmed
according to Hood
(1960).
Computer program
provided instructions,
which were followed by
an assistant who was
familiar with the use of
Teletype system.
If a response was
elicited the assistant
would type 1, no
response the assistant
would type 2. The
computer would
indicate next step.
Method of Adjustment
Békésy sweep
frequency.
Rate: 1 octave/min,
chart travel period of 6
2/3 min.
Rate of change of
intensity: 2.5dB/sec.
Thresholds read using
the mid-point mean
-Average
thresholds
and
standard
deviations.
-t-Test
conducted
on mean
values.
-Product
moment
correlation
coefficient.
- Average
thresholds
-
-
It was apparent that if
subjects were consistent in
their response, automated
testing could obtain
thresholds similar to that of
manual testing.
The t-test: no significant
difference between AC and
BC values between two
methods of testing.
Correlation coefficients: high
correlation between the two
methods of testing.
Automated and manual
testing yielded similar
thresholds, however
automated testing seemed
to be more sensitive than
manual testing.
E- 800.
Robinson
& Whittle
1973
Accuracy:
64 subjects
(128 ears),
26-73 years
old.
Test-retest
reliability:
48 subjects
(96 ears),
29-73 years
old.
Hearing
status not
indicated.
Wood et
al.
1973
20 subjects,
7-72 years
old.
Hearing
status of
subjects
included: 1
normal
Diagnostic AC
testing.
Frequencies: .25,
.5, 1, 2, 4, 6, 8
kHz.
Transducers:
TDH-39
earphones and
MX-41-AR
cushions.
Audiometer:
Manual and
automatedRudmose type
ARJ-5
Diagnostic AC,
BC testing with
masking.
Frequencies: .25,
.5, 1, 2, 4, 8 kHz.
Audiometer:
AutomatedGrason Stadler
model 829E,
value between
ascending or
descending tracing at
the frequency level.
Method of Adjustment
Békésy fixed
frequency.
Pulsed tones with a
repetition rate: 2 Hz,
cycle consisting of a
silent period of 185 ms
and a tone pulse with
65 ms rise, fall times
and a dwell of 185 ms
at maximum
amplitude, attenuator:
5dB/s.
Thresholds read as the
mid-point of the
excursions, extraneous
deviations being
ignored.
Method of limits.
Functional generator
controlled frequency of
tonal signal. Rise and
fall time: 30 sec,
duration of the tone:
1500msec.
Unmasked air and
bone:
Automated threshold yield
better results than manual
- Average
testing, except at .25 kHz
- Average
differences
where no diff was noted.
difference
and
Test-retest reliability:
s and
standard
manual and automated
standard
deviations
testing yield lower
deviation
-Linear
thresholds when tested for
s of initial
regression
the second time.
test
and
- Average
correlation
difference
coefficients
s and
.
standard
deviation
Estimation
s of
of
second
asymptom
test
atic data.
- Average
deviations
-
A high positive relationship
between manual and
automated testing for air
and bone testing was noted.
Automated testing reduces
examiner bias and causes
direct standardization of
testing.
Additionally, the use of
hearing
manual- not
subject,
indicated.
14
sensorineural
, 4 conductive
and 1 mixed
hearing loss
subject/s.
Almqvist
&
Aursnen
1978
82 subjects
(41 ears),
7-82 years.
Hearing
status not
indicated.
Screening AC,
Frequencies: .5,
1, 2, 3, 4, 6 Hz.
Audiometer:
Manualnot indicated,
Automatedminicomputer,
type PDP-8.
Tones presented using
an initial bracketing of
10 dB, then a
bracketing of 5dB.
Masking:
AC Masking- 40dB gap
between AC of test ear
and BC of non-test
ear.
BC Masking- if AC of
the
test ear
exceeded the midline
BC by more than
10dB.
Minimal effective
masking (Martin 1976)
was used / if patient
did not respond to
minimal masking than
platue masking was
administered.
Method of limits.
Computer program
utilized principles
based on manual
audiometry.
computerized program will
give the audiologist time for
direct patient contact,
counselling and aural
rehabilitation.
-Standard
deviation
-
Automated audiometry
appeared to be a fast and a
reliable method for
screening audiometry.
A total standard deviation of
4.8 dB was noted between
manual and automated
audiometry, standard
deviation varied across
frequencies and was the
smallest in the speech
Sakabe
et al.
1978
2 groups
used:
1) 31
subjects (62
ears), 19- 22
years old.
Normal
hearing
subjects.
2) 124
subjects (248
ears).
Diagnostic AC
testing.
Frequencies:
.125, .25, .5, 1, 2,
4, 6, 8 kHz.
Hearing
status not
indicated.
Erlandss
on et al.
1979
Accuracy :
115 subjects
(230 ears),
25 to 63
years.
Test-retest
reliability:
10 subjects
Diagnostic AC.
Frequencies: .25,
.5, 1, 1.5, 2, 3, 4,
6, 8 kHz.
Transducers:
Manual- TDH39M with MX41/AR cushions.
Automated- TDH-
Method of limits.
Automatically
interrupted tone, on-off
time: 2sec, rise- fall
time: 25ms.
Tone presented at
30dB, if not heard,
raised to 60dB, if
heard lowered again to
30dB and increased by
5dB till heard again.
The tone is lowered to
30dB again and raised
in 5dB steps till a
response is elicited.
Once a response is
obtained a comparison
between the 2
'thresholds' are made.
The smaller value is
the threshold obtained
at that frequency.
Method of adjustmentBékésy sweep
frequency.
Attenuation rate: 2.5
dB/s, pulsed tonepresentation; sweep
time from .25 -10 kHz
was 400s.
frequencies.
Automated audiometry has
sufficient accuracy for
practical use.
Automated audiometry
coincides with manual
audiometry within 10 dB.
Additionally it would take 515min to conduct.
- Error
analysis
-
Regressio
n
-standard
equations
deviation
and α and
s
β
coefficients
.
Automated audiometry
yields a lower and more
reliable hearing threshold
than manual audiometry.
Manual audiometry SD are
about twice as much for
automated testing.
Test-retest reliability of
automated audiometry
(20 ears).
Erlandss
on et al.
1979
All subjects
were noise
exposed
shipyard
workers.
Accuracy :
115 subjects
(230 ears),
25 to 63
years.
Test-retest
reliability:
10 subjects
(20 ears).
Harris
1979
All subjects
were noise
exposed
shipyard
workers.
12 subjects
(24 ears),
20 - 26 years
old.
Hearing
status not
indicated.
49P with MX41/AR cushions.
Audiometer:
ManualMadsen OB60,
automatedType Delmar 120.
Diagnostic AC.
Frequencies: .5,
1, 1.5, 2, 3, 4, 6,
8 kHz.
Audiometer:
ManualMadsen OB60,
automatedType Delmar 120.
Diagnostic AC.
Frequencies: .5,
1, 2, 3, 4, 6, 8
kHz.
Audiometer:
ManualTracor Model RA115, automatedSelf-recording-
Estimated
standard
deviations
Method of adjustmentBékésy sweep
frequency.
Attenuation rate: 2.5
dB/s with a pulsed
tone-presentation,
sweep time from .25-1
kHz was 400s.
Method of adjustmentBékésy fixed
frequency.
Tone pulse rate:
2.5pulses/sec was
used; tones were
presented for 30sec at
each frequency.
Attenuation rate of
Regressio
n equation
Estimated
standard
deviations
- Average
threshold
and
standard
deviation
- Average
differences
indicated that the standard
deviations between the 5
successive tests had their
lowest values for 1 kHz,
increasing slowly towards
lower and higher
frequencies.
Automated audiometry
yields a lower and more
reliable hearing threshold
than manual audiometry.
Test-retest reliability of
automated audiometry
- Average
indicated that the standard
threshold
deviations between the 5
s and
successive tests had their
standard
lowest values for 1 kHz,
deviation
increasing slowly towards
s
lower and higher
frequencies.
-
Automated audiometry,
utilizing the method of limits,
indicated results that agree
more with manual than
automated audiometry
utilizing the method of
adjustment.
At all frequencies,
automated audiometry
Tracor Model
ARJ-4C,
MicroprocessorTracor Moder
RA-40
5dB/sec in 0.25dB
steps.
Thresholds read as the
mid-point of the
excursions at each
frequency.
** Two automated Method of limits.
methods
An 800msec tone
compared to
presented at random
manual testing.
intervals of 1,2, sec.
The Hughstonwestlake method was
utilized by the
computer program.
Frampto
n&
Counter
1989
42 subjects
(84ears).
All subjects
were noise
exposed
adults.
Lutman
et al.
1989
120 subjects
(240 ears),
40 – 65 years
Diagnostic AC
testing.
Frequencies: .5,
1, 2, 3, 4, 6, 8
kHz.
Audiometer:
ManualGrason Stadler
GSI 10,
automatedGrason sStadler
1703 B
Diagnostic AC
thresholds.
Frequencies: .5,
Method of Adjustment
Békésy sweep
frequency.
7 frequency sweep
with a pulsed tone
mode.
Method of adjustmentBékésy fixed
frequency.
- Average
differences
- Average
thresholds
-
utilizing the method of
adjustment showed lower
thresholds than the other 2
tests.
Automated audiometry
utilizing the method of limits
showed higher thresholds
for all frequencies except 4
KHz, over manual
audiometry.
The two automated
audiometry tests differed
significantly at the 0.01 level
in all frequencies.
Time differences between
each test were less than a
minute.
Automated audiometry
produced lower thresholds
than manual testing.
Automated audiometry is
reliable and sensitive in the
'real world' setting.
It allows large numbers of
audiograms to be collected
quickly by medical
assistants with no training.
Automated audiometry
- Average produced better results than
difference manual audiometry.
old.
Hearing
status not
indicated.
Longitudinal
study,
subjects
retest 2-3
years later.
Fausti et
al.
1990
20 subjects
(40 ears),
18-25 years
old.
Normal
hearing
adults.
1, 2, 3, 4 kHz.
Transducers:
ManualTDH-39P with
MX 41/AR
cushions
AutomaticTDH-49P with
MX -41/AR
cushions
Stimulus tone pulsed
at a rate:
2.5pulses/sec, with
duration of 200ms
(3dB down points).
The tracking procedure
: 2dB step occurring
every 2 pulses.
Tracking at each
frequency lasted
40sec, 50 levels were
visited for each
frequency.
Diagnostic AC
testing.
Frequencies: .25,
0.5, 1, 2, 4, 8
kHz.
Audiometer:
ManualGS1701,
Automated- V320
Method of limits.
V 320 Audiometer
used, tones presented:
50% duty cycle,
duration: 250 ms , risefall time: 25-50ms.
Modified Hughson
Westlake
Ascending-descending
audiometric test
technique .
and
standard
deviations
- Ranges
of
thresholds
- Average
difference
- Two-way
analysis of
variance
with
repeated
measures
on
frequency
and
system s
s and
standard
deviation
s
Standard
of
variance
Overall automated
audiometry was 4.4 dB
better than manual
audiometry; the difference
was lower at .5 kHz and
increased as the frequency
increased.
Test-retest reliabilitymanual audiometry
indicated a worsening of
hearing at .5,1, 2 kHz and
an improvement at 4 kHz.
Automated audiometry
produced correlation
coefficients which were
statistically significant,
however it suggests the shift
is due to random
measurement error rather
than actual shifts in the
threshold.
No significant difference
was noted between
automated and manual
testing over all test
- Average frequencies.
absolute
Test-retest reliability:
difference indicated no significant
s
difference between the two
tests conducted.
- Sheffé’s
to
determine
statistical
significanc
e.
Picard et
al.
1993
3 groups
used:
1) 420
subjects (840
ears), 18-64
years old.
Noise
exposed
workers.
2) 36 elderly
subjects (72
ears), 65-80
years old.
Hearing
status not
indicated.
3) 12
subjects (24
ears), 7.5- 12
years old.
Normal
hearing
children.
Diagnostic AC
and BC testing
with masking.
Frequencies:
AC- .5, 1, 2, 3, 4,
6 kHz.
BC- .5 ,1, 2, 4
kHz.
Audiometer:
AutomatedMADSEN, Model
OB 822, manual
not indicated.
Method of limitsBOBCAT.
Tone duration of
700ms, 2s time
interval.
The computer program
made use of the
ascending- descending
method (ISO 6189).
Masking:
Hood technique of
masking used.
AC Masking- 40dB gap
between AC of test ear
and BC of non-test
ear.
BC Masking- AC of the
test ear exceeded the
midline BC by more
than 10dB.
- Reliability
coefficients
using
Hoyt’s
solution.
- Average
thresholds
and
standard
deviation
Dispersion
relationshi
ps
-
Manual and automated
procedures produce similar
results, regardless of
subject age, degree of
hearing loss or nature of
hearing loss. Mean
thresholds across the
populations comparable
between automated and
manual testing.
Automated testing with the
child population did not
reveal consistent results
when compared to manual
audiometry, especially at 2
and 6 kHz.
Automated testing takes
longer to determine
thresholds than manual
testing (automated- 42 sec,
manual- 34 sec).
It was noted as population
changed to 'difficult to test'
patients (children) manual
testing started to take more
time. It was also noted that
Fromby
et al.
1996
Accuracy:
101 subjects
(202 ears),
mean age of
43 years.
Noise
exposed
workers.
Test-retest
reliability:
20 subjects
(39 ears),
Mean age of
43 years.
Noise
exposed
workers.
Diagnostic AC
testing.
Frequencies: .25.
.5, 1, 2, 3, 4, 6, 8
kHz
Transducer:
Telephonics
TDH-39.
Audiometer:
ManualMadsen, model
OB822,
automateddigital-to-analog
converter
(DAC) (TDT,
model Quikki
QDA1).
Method of limitsMaximum likelihood
method was used
(ML).
Threshold for each
frequency was
measured in 15-trial
block to yield 60%
correct detection. On a
trial, a 200msec puretone signal presented
in a visually cued
200msec observation
interval.
Signals: 10-msec risefall times as part of the
nominal durations.
Subjects had 1000
msec to make a "yesonly" response which
attenuated the signal
level. If the subject did
not respond during the
1000-msec response
period, the computer
assumed a "no"
response for the trial,
and the signal level
- Average
threshold
- Standard
error bars
examiner takes shortcuts to
obtain results but automated
testing maintains rigid
adherence to full procedure.
Automated testing and
manual testing yielded
similar results.
Threshold differences
between the two methods
were not statistically
significant at any test
frequency except .25 kHz,
automated threshold was
higher, but was within 3 dB
of the threshold obtained
manually.
- Average Test- retest reliability for
threshold automated testing: no
significant test-retest
Standard differences at any test
error bars frequency.
Additionally, manual testing
took less time than
automated testing (manual3 min 46 sec, auto-6 min 43
sec).
Margolis
et al.
2007
3 groups:
1) 120
subjects,
16-93 years
old.
Hearing
status varied.
2) 8 subjects,
64- 85 years
old.
Varying
degrees of
hearing loss.
3) 6 subjects,
13- 86 years
old.
Varying
degrees of
hearing loss.
Diagnostic AC,
BC and masking.
Frequencies: not
indicated.
Transducers
varied for
different groups
tested.
Group 1 and 2:
Manual- TDH-50,
automatedprototype, nonoccluding
circumaural
earphones
Group 3:
Manual- TDH-50
(not test ear
occluded during
BC testing),
automated- insert
earphones ER3A
(both ears
occluded during
BC testing)
was increased
according to the ML
algorithm.
Method of limitsAMTAS.
Tonal stimuli
presented in a
temporal observation
interval that is visually
marked for the listener,
following the
observation interval,
the listener responds
YES or NO by
touching ‘buttons’ on a
touchscreen monitor.
The signal level is
changed in an
adaptive fashion to find
the threshold of
audibility.
A threshold is obtained
using a bracketing
procedure.
Masking noise
presented to the nontest ear at levels that
are selected to
maximize the
likelihood that neither
under-masking nor
over-masking will
-Average
absolute
differences
(QAave)
Regressio
n
coefficients
QUALIND
Correlation
coefficients
-
The aim of this study was to
develop a quality
assessment method
(QUALIND) based on a
comparison of audiograms
obtained utilizing automated
(AMTAS) and manual
testing.
A predictive equation was
derived
from a multiple regression of
a set of quantitative quality
indicators on a measure of
test accuracy, defined as
the average absolute
difference between
automated and manually
tested thresholds. For a
large subject sample
(n=120), a strong
relationship was found
between predicted and
measured accuracy.
The predictive equation was
cross validated against two
independent data sets.
The results suggest that the
predictions retain their
accuracy for independent
occur.
Ho et al.
2009
3 groups
used:
1) 16
subjects (32
ears), 20- 80
years old.
2) 16
subjects (32
ears), 23-80
years old.
3)16 subjects
(32 ears), 2381 years old.
Hearing
status of all 3
groups
unknown.
Diagnostic AC
and BC testing
with masking.
Frequencies:
AC- .25, .5, 1, 2,
3, 4, 6, 8 kHz.
BC- .5,1, 2, 4 kHz
Transducer:
EAR 5A.
Audiometer:
Manual- not
indicated,
AutomatedOtogram.
Method of limitsOtogram.
Assesses AC and BC
thresholds, administers
masking when
appropriate.
Uses touch-screen
technology
programmed according
to the HughsonWestlake algorithm.
- Average
Difference
s and
standard
deviations.
- Levels of
agreement
were
analysed
and
expressed
by
weighted ҡ
coefficients
, using
SPSS
version 15
and
StatXact
version
Average
Differenc
es and
standard
deviation
s.
- Levels
of
agreeme
nt were
analysed
and
expresse
d by
weighted
ҡ
coefficien
ts, using
SPSS
data sets if similar subjects
and methods are employed,
and that new predictive
equations may be required
for significant variations in
test methodology. The
method may be useful for
automated test procedures
when skilled professionals
are not available to provide
quality assurance.
AC and BC results when
tested with automated and
manual testing produced
similar results.
AC thresholds when tested
using automated and
manual testing indicated
94% of automated
thresholds that fell within 10
dB of those obtained
manually and indicated 10
paired thresholds that fell
within 15 dB of manual
testing.
BC unmasked thresholds
showed that 93% of
automated thresholds fell
within 10 dB of each other
and 96% fell within 15 dB of
each other.
BC masked thresholds
8.0.
McPhers
on et al.
Margolis
et al.
2010
2010
80 subjects
(160 ears), 78 years old.
Accuracy:
30 subjects
Screening AC
tested.
Frequencies: .5,
1, 2, 3, 4 kHz.
Transducers:
ManualCircumaural ME70 enclosures
over TDH-39
supra-aural
earphones.
AutomatedCircumaural
headphone
Ovann OV880V.
Audiometer:
Manual- Madsen
Micromate,
automated- IBM
ThinkPad laptop
PC, model T22.
Diagnostic AC,
BC and masking.
Methods of
adjustment.
Békésy fixed
frequency.
Continues tones of 1
sec were presented in
left ear at .5 kHz at 40
dB, and were raised or
lowered in 3dB steps
depending on
response. Thereafter
1-4 kHz tested.
Method of limitsAMTAS (see Margolis
-X²-test
-Sensitivity
or
specificity
analysis
- Individual
test results
for each
ear was
compared
using
kappa
values of
agreement
.
- Average
version
15 and
StatXact
version
8.0.
-
-
between the 2 tests showed
a lower level of agreement
but still a good level of
agreement.
Test-retest reliability
indicated good intrarater
agreement between the
automated and manual
testing conducted.
Automated screening
procedure produced higher
referral rate than manual
screening (56% versus
13%). However, when .5
kHz was excluded from the
data the referral rate
between the two methods
indicated no significant
difference.
The reason for .5 kHz
producing errors could be as
a result of ambient
environmental noise and
that automated audiometry
started at .5 kHz and
subjects were unfamiliar to
test procedures.
The differences between
automated and manual
(60 ears).
Hearing
status:
5 normal
hearing
subjects, 25
hearing loss
subjects.
Test-retest
reliability:
18 subjects
(36 ears).
Hearing
status:
3 normal
hearing
subjects, 15
sensorineural
hearing loss
subjects.
Swanepo
el et al.
2010
2 groups
used:
1) 30
subjects (60
ears), 18- 31
years old.
Normal
hearing
Frequencies: AC.25, .5, 1, 2, 3, 4,
6, 8 kHz.
BC- .5, 1, 2, 4
kHz
Transducer: ACSennheiser
HDA200
BC manualRadioear
B71(mastoid
placement)
BC automatedB71 vibrator
(forehead
placement).
Audiometer:
Manual and
automatedMadsen Conera.
et al, 2007).
Diagnostic AC
and masking.
Frequencies:
.125, .25, .5, 1, 2,
4, 8 kHz.
Audiometer:
Manual and
automated-
Method of limits.
Modified HughsonWestlake method.
Software presented a
tone for 1.25s,
subjects had to
respond within 1.5 s
before the next tone
differences
-Average
Absolute
differences
Confidenc
e intervals
- Absolute
average
differences
and
standard
deviations
- Two
testing were compared to
differences obtained when
the same subjects are
tested manually by two
audiologists.
AC thresholds obtained by
manual and automated
testing indicated similar
differences that were
obtained when the same
patients were tested
manually by two
audiologists.
BC thresholds obtained with
automated testing were
lower than thresholds
obtained with manual
testing. The difference could
be due to the placement of
the bone conductor.
Absolute
average
difference
s and
standard
deviation
Thresholds determined by
manual and automated
testing were within 5 dB of
each other, indicating no
significant difference
between the two test
procedures, in both the
hearing and hearing loss
Ishak et
al.
2011
adults.
2) 8 subjects
(16 ears),
average age
of 55 years
old.
Subjects had
a
sensorineural
hearing loss
ranging from
mild to
severe
hearing loss.
Accuracy:
13 subjects
(13 ears), a860 years old.
Normal
hearing
adults.
Test-retest
reliability:
21 subjects
(21 ears),
18-60 years
old.
Normal
hearing
adults.
KUDUwave 5000. was presented.
Threshold was
accepted if there was a
minimum of 3
responses.
Software automatically
determined if
contralateral masking
was necessary and
applied when required
in an adaptive manner.
Diagnostic AC
testing.
Frequencies: .25,
.5, .75, 1, 1.5, 2,
3, 4, 6, 8 kHz.
Audiometer:
Manual and
automatedEssilor Audioscan
system.
** Test-retest
reliability was
determined by
testing subjects 4
times with each
test producer.
Method of adjustmentBékésy sweep
frequency and
Audioscan.
Békésy:
Sweep rate: 15 s per
octave, pulse rate: 2.5
pulses/s, attention
rate: 2.5dB/s was
used.
Hearing thresholds
determined by
calculating averaged
values of three
consecutive
audiometric data
obtained around each
octave or half-octave
sided
paired ttest
- Pearson
correlation
coefficients
s
- Two
sided
paired ttest
- Pearson
correlatio
n
coefficien
ts
Threshol
ds from
- Repeated each test
measures
session
ANOVA
were
- Contrasts subtracte
analysis to d
compare
mean
Variance
thresholds. of
hearing
threshold
(σ2)
group.
Test-retest reliability of
automated testing indicated
reliability equivalent to that
of manual testing.
Additionally, both manual
and automated testing took
more or less the same time
to administer (manual- 7.27.7 min, automated- 7.2-7.4
min).
The results showed that the
thresholds obtained with
Békésy testing were
significantly better than
those obtained from the
manual testing at most
frequencies.
Audioscan produces better
thresholds than Békésy,
showing no significant
differences in hearing
thresholds at frequencies
from .5 kHz- 4 kHz.
Hearing thresholds obtained
from Audioscan were
significantly poorer than
manual testing at
frequencies of .25, 6 and 8
Margolis
et al.
2011
2 groups:
1) 68
subjects (136
ears),
4- 8 years
old (1 group
of 4-5 year
olds and
another
group of 6-8
year olds).
Normal
Diagnostic AC
testing.
Frequencies:
.5, 1, 2, 4, 8 kHz.
Transducers:
Automated- HDA
200
Manual- TDH-50.
Audiometer:
Manual and
automated
(children)-
frequencies.
These values were
rounded to the nearest
5dB for the analysis.
Audioscan:
Sweep rate:
15sec/octave, tones
swept 1- 8 kHz, back
to 1 kHz and swept
again from 1 kHz to
.25 Hz.
A straight line was
produced when the
subjects pressed the
response button. The
level was then
increased by 5dB at
frequencies to which
the subjects did not
respond.
Method of limitsAMTAS was used for
the adult group (see
Margolis et al, 2007).
KIDTAS was used for
the child population. It
differed from AMTAS,
used a smiley and sad
face and a visual
reinforcement picture
for a correct response.
Additionally, QUALIND
kHz. This was probably due
to the threshold seeking
procedure, which does not
allow the intensity level to
go either higher or lower
than the current screening
intensity level.
High test-retest reliability for
manual and audioscan
testing, however, Békésy
testing indicated poor testretest reliability.
- Average
absolute
average
difference
and
standard
deviation
-
The differences obtained
between automated testing
(AMTAS/KIDTAS) and
manual testing produces
thresholds with variability
that is comparable to
thresholds obtained using
manual testing by two
audiologists, only if
QUALIND identifies and
excludes ‘poor’ audiograms.
No significant differences
Margolis
& Moore
2011
hearing
children.
2) 15
subjects ,
Adults.
Hearing
status:
11 normal
hearing, 1
unilateral
hearing loss,
3 mild-tomoderate
bilateral
hearing loss
subjects.
Benson CCA-100
Mini.
Manua (adults)lGrason Stadler,
automatedBenson CCA.
13 subjects
(19 ears), 2165 years old.
Diagnostic AC,
BC and masking.
Frequencies: .25,
.5, 1, 2, 4, 8 kHz.
Audiometer:
Manual- Grason
All subjects
had a
**Different
transducers were
only used in the
adult population.
was used. QUALIND is
a method for
estimating accuracy by
tracking variables that
are known to predict
agreement between
automated and manual
thresholds, and
calculating the
predicted average
absolute difference
with a formula derived
from a regression
analysis of the
relationship between
the quality indicators
and the measured
average absolute
differences. The
strength of the
regression coefficient
indicates the degree to
which accuracy can be
predicted by
QUALIND.
Method of limitsAMTAS (see Margolis
et al, 2007).
between manual and
automated thresholds were
noted when using different
earphones in the adult
subjects.
- Average
thresholds
-Average
differences
-Average
-
Automated testing produced
thresholds similar to those
obtained by manual testing
results. Automated
thresholds were higher than
those obtained manual by 7
sensorineural
hearing loss.
Stadler
GSI 61,
AutomatedMadsen Aurical.
absolute
differences
-Analysis
of variance
(ANOVA)
dB at .25, .5, 1, 2 kHz, with
smaller differences at higher
frequencies.
According to Margolis et al
(2010) results between
manual and automated
testing should be similar,
thus it was concluded by
this study that the difference
noted between the two test
results was due to the use
of different earphones.